BVA9503927
DOCKET NO. 93-08 082 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in Atlanta,
Georgia
THE ISSUE
Entitlement to an increased evaluation for acne keloid scarring
of the neck and abdomen, currently evaluated as 10 percent
disabling.
ATTORNEY FOR THE BOARD
Rebecca A. Kelly, Associate Counsel
INTRODUCTION
The veteran served on active duty from August 1980 to May 1986.
This appeal arises from a July 1991 rating decision of the
Atlanta, Georgia, Department of Veterans Affairs (VA), Regional
Office (RO), which found that the veteran was not entitled to an
increased evaluation for his service-connected acne keloid with
scarring of the neck and abdomen. This decision confirmed and
continued the original evaluation of 10 percent granted in June
1991.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant contends, in essence, that the scars from his
service-connected acne keloid, are much worse than the current
evaluation of 10 percent might suggest. He argues that his scars
are severe in nature and that the clustered keloids are
disfiguring because of the extensive skin area that is covered.
He asserts that he cannot shave regularly and his scalp
constantly itches which can only be alleviated by constant use of
medicated shampoo and cream. He further asserts that his hair
cannot be cut without the keloids multiplying nor can his hair be
brushed without causing the keloids to bleed and become infected.
He argues that jobs are hard to find when one is not clean
shaven.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter, and
for the following reasons and bases, it is the decision of the
Board that the preponderance of the evidence is against the
appellant's claim for an increased evaluation for acne keloid
scarring of neck and abdomen.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable disposition
of the appellant's appeal has been obtained by the RO.
2. The veteran's acne keloid scarring of the neck and abdomen is
not manifested by constant itching or exudation, extensive
lesions or marked disfigurement. Nor are his scars severe so as
to produce a marked or unsightly deformity on his eyelids, lips
or auricles.
CONCLUSION OF LAW
A disability evaluation greater than 10 percent for acne keloid
scarring of the neck and abdomen is not warranted. 38 U.S.C.A.
§§ 1155, 5107(a) (West 1991); 38 C.F.R. § 3.321, Part 4,
including § 4.1, 4.2, 4.7, 4.10, 4.118, Diagnostic Code 7806-7800
(1993).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Initially, the Board finds that the appellant has submitted
evidence which is sufficient to justify a belief that his claim
is well grounded. 38 U.S.C.A. § 5107(a)(West 1991) and Murphy v.
Derwinski, 1 Vet.App. 78 (1990). That is, we find that he has
presented a claim which is plausible. We are also satisfied that
all relevant evidence has been obtained. There is no indication
in the record that there are other records available that should
be obtained. Therefore, no further development is necessary in
order to comply with the duty to assist mandated by 38 U.S.C.A. §
5107(a).
In evaluating the appellant's request for an increased rating,
the Board considers the pertinent evidence of record, including
the entire medical history. Schafrath v. Derwinski, 1 Vet.App.
589 (1991). The medical findings are compared to the criteria in
the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. In
so doing, it is our responsibility to weigh the evidence.
Gilbert v. Derwinski, 1 Vet.App. 49 (1990).
Factual Background
A review of the service medical records revealed that in April
1981 the veteran presented with complaints of bumps on the back
of his neck that had lasted six months; it had first appeared
after a haircut. The veteran was examined by a dermatologist who
noted papules at the hairline of his neck that were three
millimeters in diameter; he made a diagnosis of keloid acne.
While on active duty, the veteran experienced some improvement as
he continued treatment of his skin condition with topical
cortisone cream, Betadine solution, and steroid injections. The
veteran's separation examination noted multiple small keloids on
the neck and abdomen. After the veteran's discharge in 1986, he
did not receive any treatment for acne keloid scarring of the
neck and abdomen until 1990.
The veteran's air force reserve treatment records from June 1990
to March 1991 showed that he presented with complaints of
worsening acne keloids on the back of his neck after a haircut.
In July 1990, the veteran was treated and the examination showed
some acne along the hairline; a waiver was authorized so he could
forego military reserve haircut requirements for an indefinite
period of time. In September 1990, the annual examination showed
small keloids on the veteran's back and abdomen and under his
chin.
In April 1991, a private physician submitted a letter that stated
he currently was treating the veteran for keloid scars on the
neck. He indicated that future treatment might include laser
treatment.
In October 1991, outpatient records showed that the veteran
presented complaints of keloids. The examination revealed pebbly
keloidal papules that coalesced over the occiput and linear
keloids were in the bearded area of his face. The impression was
keloids and pseudofolliculitis barbae.
The veteran was examined by VA in December 1991 and reported that
since 1982 he has had problems with acne vulgaris on his neck
area, in the bearded area of his face and on the trunk of his
body. Outpatient treatment was being provided by a VA
dermatology clinic. The veteran was noted to have said that he
was glad the acne had not gotten any worse. A physical
examination of the skin showed pseudofolliculitis barbae in the
bearded area of his face and along the perimeter of his beard
were keloidal lesions that had apparently developed from previous
lesions of pseudofolliculitis barbae. A confluent area of
keloidal papules coalesced on the nuchal area of the neck and was
suggestive of acne keloidalis nuchae; no inflammatory papules
were noted. On the trunk, there were macular hyperpigmented
areas measuring about 3 mm to 5 mm in diameter; no papules,
pustules or cysts were noted. The diagnoses were
pseudofolliculitis barbae and acne keloidalis nuchae.
VA outpatient records from May to September 1992 did not reflect
any complaints, findings or diagnoses pertaining to the veteran's
service-connected disability of acne keloidal scarring of the
neck and abdomen.
Analysis
In determining an increased evaluation of a disability, the VA
has a duty to acknowledge and consider all regulations which are
potentially applicable based upon the assertions and issues
raised in the record and to explain the reasons used to support
the conclusion. Schafrath v. Derwinksi, 1 Vet.App. 589 (1991).
These regulations include, but are not limited to, 38 C.F.R.
§ 4.1, that requires that each disability be viewed in relation
to its history and that there be an emphasis placed upon the
limitation of activity imposed by the disabling condition, and 38
C.F.R. § 4.2 which requires that medical reports be interpreted
in light of the whole recorded history, and that each disability
must be considered from the point of view of the veteran's
working or seeking work.
Under the applicable criteria, disability evaluations are
determined by the application of a schedule of ratings which is
based on the average impairment of earning capacity. Separate
diagnostic codes identify the various disabilities. 38 C.F.R.
§ 1155 (West 1993); 38 C.F.R. Part 4 (1993). When a question
arises as to which of two evaluations shall be assigned within a
diagnostic code, the higher evaluation will be assigned if the
disability picture more nearly approximates the criteria required
for that rating. Otherwise, the lower rating will be assigned.
38 C.F.R. § 4.7 (1993). Moreover, 38 C.F.R. § 3.321(b)(1)
provides that an extra-schedular rating may be granted where the
disability picture is exceptional or unusual with such related
factors as marked interference with employment or frequent
periods of hospitalization to render impractical the application
of the regular schedular standards.
The applicable schedular criteria under Diagnostic Code 7806
provide that a 10 percent evaluation is warranted for eczema with
exfoliation, exudation or itching with involvement of an exposed
surface or extensive area. The current 10 percent evaluation
under Diagnostic Code 7800 contemplates not more than moderate
facial disfigurement due to facial scarring. The next higher
evaluation of 30 percent under Diagnostic Code 7806 requires
eczema with constant exudation or itching, extensive lesions or
marked disfigurement. The next higher evaluation of 30 percent
under Diagnostic Code 7800 contemplates severe facial
disfigurement due to scarring.
In the instant case, the veteran has requested a higher
disability evaluation be assigned his acne keloid scarring of the
neck and abdomen that is currently evaluated as 10 percent
disabling under Diagnostic Codes 7806-7800. However, an
increased evaluation of 30 percent is not shown by the objective
evidence of record.
After carefully reviewing the evidence of record, it is the
finding of the undersigned that an increased evaluation of 30
percent for the veteran's service-connected disability of acne
keloid scarring of the neck and back is not warranted. The
objective evidence of record was silent as to any findings of
constant itching, exudation, extensive lesions or marked
disfigurement; therefore, the VA special dermatological
examination conducted in December 1991 did not substantiate the
above diagnostic requirements. Moreover, the record was devoid
of any evidence, subjective or objective, that would corroborate
his contention of such severe acne keloidal scarring of the neck
and abdomen from either a marked or unsightly deformity of his
eyelids, lips or auricles.
What the evidence has demonstrated is that the appellant's acne
keloidal with scarring of neck and abdomen has remained unchanged
since the April 1991 evaluation and is adequately compensated by
the 10 percent evaluation currently assigned. First of all, the
subjective evidence contains the veteran's own observation that
he was glad his skin condition had not gotten any worse. The
objective evidence of record shows that the veteran has exposed
areas of skin on the back of his neck and in the bearded area of
his face that contained keloidal lesions and pseudofolliculitis
barbae, although there was no finding of exudation, exfoliation
or constant itching. Scarring from keloidal lesions had occurred
along the bearded area of the veteran's face, as a result of the
previous lesions of pseudofolliculitis barbae and areas of
hyperpigmentation were found on his torso; however, the degree of
scarring was moderate. Moreover, the objective evidence
substantiates the effectiveness of his treatment by VA based on
the absence of any inflamed papules or pustules in any of the
affected areas.
Nor does the evidence of record establish that an extraschedular
evaluation is warranted under 38 C.F.R. § 3.321. The disability
in question has not resulted in frequent periods of
hospitalization. Although the veteran contends that his unshaven
appearance makes it very difficult to find employment, there is
nothing of record to indicate that he is currently unemployed or
that he has had difficulty in maintaining employment due to any
physical impairment from his service-connected disability.
In conclusion, it is the finding of the undersigned that the
preponderance of the evidence is against the appellant's claim
for an increased evaluation for acne keloid scarring of the neck
and abdomen.
ORDER
An increased disability evaluation for acne keloid scarring of
the neck and abdomen is denied.
C.P. RUSSELL
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988. Veterans' Judicial
Review Act, Pub. L. No. 100-687, § 402 (1988). The date which
appears on the face of this decision constitutes the date of
mailing and the copy of this decision which you have received is
your notice of the action taken on your appeal by the Board of
Veterans' Appeals.